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MANAGEMENT OF MENINGOCOCCAL
MENINGITIS AND SEPTICAEMIA
CLINICAL GUIDELINE
Developed in response to:
CNST Best Practice
Contributes to HCC Core Standard number
C4a
Version Number
Issuing Directorate
Approved by
Approved on
Implementation Date
Next Review Date
Author/Contact for Information
Policy to be followed by (target staff)
Distribution Method
Related Trust Policies (to be read in
conjunction with)
3.0
Governance
Clinical Document Approval Group
28th March 2008
28th March 2008
1 November 2010
Infection Prevention Team
All Trust Staff
Intranet & Website
All infection control policies
Professional Approval Prior to Ratification,
name and date.
Circulated to Clinical Directors
Document Review History
Review No
1.0
2.0
3.0
Registration Number
Reviewed by
Infection control team
Infection control team
Infection Prevention
team
Review Date
2003
June 2004
January 2008
08030
Index
1.
Introduction
2.
Route of Spread
3.
Characteristic of Meningococcal Disease
4.
Immediate Response at Admission
5.
Specimen Collection
6.
Cases requiring Public Health Action
7.
Cases not requiring Public Health Action
8.
Infection Prevention and Control Management
9.
Meningococci Group C Vaccination
10
Who should receive Prophylaxis
11
Action to be taken in hospital for contacts
12
Monitoring
13
Reference
Appendix 1 Administration of Prophylactic Rifampicin for Prevention of
Meningococcal Infections
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1.
Introduction
1.1
Neisseria meningitidis
Neisseria meningitidis is the organism responsible for meningococcal disease. It is a
human pathogen that resides in the nasopharynx of healthy carriers but causes
disease when it enters the tissues or blood.
Meningococcal meningitis is a severe, sometimes life threatening, infection of the
membranous layers enclosing the brain and spinal cord. Meningococcal septicaemia is
an even more severe infection in the blood stream.
1.2
Meningococcal infection occurs throughout the world with seasonal variations. In the
United Kingdom most cases are reported in winter and spring.
1.3
The disease is most common in young babies, children and teenagers but may occur
at any age. Rapid treatment of this infection is imperative.
2.
Route of spread
2.1
Neisseria meningitidis is spread from one person to another by droplets from the
respiratory tract. Spread may also occur during the first 48 hours of antibiotic therapy.
3.
Characteristics of Meningococcal Disease
3.1
Transmission of Neisseria meningitidis is usually by droplet inhalation or direct contact
with discharge from the nasopharynx.
3.2
The incubation period is up to 7 days after contact but normally 2-4days.
3.3
It is rare for contacts to develop the disease. However, contacts may acquire
colonisation/carriage of the organism in their nasopharynx. These contacts may then
transmit the organism to other people.
3.4
The onset of the meningitis is often sudden and characterised by fever, malaise,
headache, nausea/vomiting and neck stiffness with or without photophobia.
3.5
Meningococcal disease may also be accompanied by a purpuric rash that does not
blanch under pressure.
4.
Immediate Response at Admission
4.1
If diagnosed by a GP, they should have given an injection of Benzylpenicillin
immediately if a diagnosis of meningitis or septicaemia is suspected.. If the patient has
not had this antibiotic prior to admission it should be given as soon as possible after
arrival in hospital.
4.2
All patients with suspected meningococcal disease must be notified to the Infection
Prevention and Control Team on admission.
4.2
Treatment following admission should be discussed with the Consultant Microbiologist.
4.3
Contacts at risk of colonisation should be identified and given the appropriate
chemoprophylaxis.
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5.
Specimen Collection
For patients who have a suspected diagnosis of Meningococcal disease the following
specimens need to be taken:




Cerebral Spinal Fluid (CSF) -If clinically indicated
Blood Culture
EDTA Blood for PCR examination
Nose and Throat Swab (from the index case only)
6.
Cases requiring Public Health Action
6.1
Confirmed case
Clinical diagnosis of meningitis, septicaemia or other invasive disease (e.g. orbital
cellulites, septic arthritis)*
AND at least one of:




Neisseria meningitides isolated from normally sterile site
Gram negative diplococci in normally sterile site
Meningococcal DNA in normally sterile site
Meningococcal antigen in blood, CSF or urine
Although not meeting the definition of a confirmed case, meningococcal infection of the
conjunctiva is considered an indication for public health action because of the high
immediate risk of invasive disease.
6.2
Probable case
Clinical diagnosis of meningitis or septicaemia or other invasive disease where the
public health physician, in consultation with the physician and microbiologist, considers
that meningococcal infection is the most likely diagnosis. Some microbiological tests
(e.g. rising antibody levels) that are not considered sufficient to confirm the diagnosis of
meningococcal disease may change the case category from ‘possible’ to ‘probable’.
7.
Cases not requiring public health action
7.1
Possible cases
Clinical diagnosis of meningitis or septicaemia or other invasive disease where the
public health physician, in consultation with the clinician and microbiologist, considers
that diagnoses other than meningococcal disease are at least as likely. This category
includes cases who may have been treated with antibiotics but whose probable
diagnosis is viral meningitis.
In such cases, prophylaxis for contacts in not indicated but giving out information about
meningococcal disease may be helpful.
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7.2
Infection in non-sterile sites
Isolation of meningococci from sputum or from swabs taken from nasopharynx or
genital tract is not by itself an indication for public health action as asymptomatic
carriage in the respiratory and genital tract is common. However, when assessed
together with other clinical and microbiological parameters, a positive throat swab may
increase the index of suspicion that this is a probable case, especially if the isolate is a
virulent strain. Meningococcal pneumonia is not an indication for public health action
but may carry a low risk of transmission in healthcare settings especially to the
immunocompromised.
8.
Infection Prevention and Control Management
8.1
The patient must be nursed in a single room with the door kept closed. A risk
assessment should be undertaken with the infection prevention and control team as to
whether an individual patient’s care will be compromised in a side room.
8.2
Disposable gloves and aprons should be worn for direct contact with the patient or any
equipment
8.3
Protective clothing should be removed and disposed of inside the room and hands
washed before leaving.
8.4
These precautions should be maintained for 48 hours for meningococcal disease.
8.5
Prior to discontinuing isolation the patient must be given a complete course of specified
oral antibiotics (usually Rifampicin), this will be different to them given for treatment
and will eliminate nasopharyngeal carriage of the organism.
9.
Meningococcal Group C Vaccination
Since 1999 there has been a vaccination available for babies, children and young adults
against Group C Meningococcal Disease. Staff and parent /relatives must be encouraged not
to discount a diagnosis of meningococcal disease because an individual has been vaccinated.
Groups A and B meningococcal disease continue to cause disease in the UK.
10.
Who should receive Prophylaxis
10.1
It is the responsibility of the Health Protection team to trace contacts and organise
prophylaxis. Clinical teams may be asked to prescribe if any delay could otherwise
occur.
10.2
Decisions regarding the administration of chemoprophylaxis within the community will
be made by the Consultant in Communicable Disease Control
10.4
Prophylaxis should be given to appropriate contacts whenever a patient presents in
whom meningococcal meningitis, septicaemia or other invasive infection with
meningococci is considered the most likely diagnosis.
10.5
Household contacts have a slightly increased risk of developing meningococcal
disease in comparison with the general population. This is the only group that requires
prophylaxis, other than kissing contacts of the index case. Most secondary cases will
occur within the first 7-14 days, but an increased risk is present for up to a year. Thus
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when the infecting organism is group C, A, W135 or Y, vaccination is also offered to
those who received antibiotics. For W135 and Y strains vaccination is on a named
patient basis.
10.6 Hospital staff only require prophylaxis if an individual has been splashed by
respiratory secretions in association with infection. Contacts should begin antibiotic
prophylaxis within 24 hours of diagnosis of the index case.
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Action to be taken in Hospital for Contacts
11.1
The clinical team caring for the patient to prescribe antibiotics from the hospital
pharmacy for those in the immediate household (normally parents and siblings). This is
because household contacts will often be sitting with the patient and will find it difficult
to visit their GP within 24 hours.
11.2
Rifampicin is usually prescribed for chemoprophylaxis, see the British National
Formulary for doses.
11.3
Rifampicin should not be given in the presence of jaundice or known allergy. It
interacts with the action of anticoagulants, reduces the efficacy of the contraceptive pill
and stains contact lenses.
11.4
If Rifampicin is contraindicated please discuss alternatives with the Consultant
Microbiologist on-call.
12.
Monitoring
12.1
The effectiveness of the policy is monitored through the annual trust wide
documentation audit coordinated through the Clinical Audit Department. The Infection
Prevention and Control Committee reviews the Infection Control policies and Divisions
are required to develop localised action plans which are monitored through their
Directorate Governance Improvement Plans.
12.2
A Trust wide Clinical Documentation summary report is presented annually to the
Information Governance Committee for review to enable monitoring at a wider level
across the organisation-good standards of clinical documentation help reduce the
potential for clinical risk incidents occurring.
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Reference:
PHLS Guidelines for public health management of meningococcal disease in the UK. (2002)
Vol. 5 No 3 Reprint PP 187-204 plus Appendices.
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APPENDIX 1
Administration of Prophylactic Rifampicin for Prevention of Meningococcal Infections
Doses
Adults: Two capsules (600mg) twice a day for two days
Child; Varies with the age and weight of the child. Should be 10mg/kg for children 1-12 yr,
and 5 mg/kg for those under 1yr. This should also be taken twice a day for two days
Take the Rifampicin at 12 hourly intervals and ONE hour before meals to obtain the best
effect
Side Effects
As no drug is entirely free of side effects the following should be noted;
Rifampicin will stain urine, sputum and tears orange, and permanently stain soft contact
lenses if they are worn while the tears are coloured
Rifampicin can interfere with oral contraceptives (The Pill). Family Planning Association
Advice
(FPA) is that extra precautions should be taken for at least 4 weeks, and there should be no
break between courses of tablets (inactive tablets should be omitted).
Avoid drinking alcohol while on the drug
Headache, feeling sick and/or stomach pain may occur while on the drug. Please contact your
doctor if symptoms are severe or other symptoms develop.
The aim of the antibiotics is to remove the meningitis bacteria from the throat, so that they
cannot be passed on to others, NOT to prevent infection in those already incubating the
illness.
Therefore there is a small chance that in spite of antibiotics you will still develop meningitis.
Seek medical help promptly if you are worried.
Alternatives
For the treatment of contacts of patients with meningococcal disease ONLY
Ciprofloxacin 500 mg ONCE.
Slightly less effective, not licensed for use in children or pregnant women, but convenient
Ceftriaxone 250 mg ONCE (125 mg in child under 12 yr).
Given as an injection.
Useful in pregnancy and where children will not take oral treatment
For further information
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